Statement of Purpose Geopolitical changes and increases in man-made and natural mass casualty incidents (MCIs) make preparation for such events more critical. The objective of this study is to understand those preparedness activities that are most effective in securing a successful response to MCIs. To achieve this goal, RAND was commissioned by the Department of Health and Human Services/Office of the Assistant Secretary for Preparedness and Response to develop a peer assessment tool that was pilot-tested in three communities across the United States that had recently experienced an incident.

Approach An interview protocol was developed based on a literature review of past domestic and international MCIs, after action reports from previous domestic incidents, expert opinion, and previous RAND post-incident evaluation tools. The protocol, designed for use by peer assessors, was pilot-tested in three communities that had recently experienced MCIs and sought to elicit successes, challenges, innovative adaptations, lessons for other communities, and related recommendations.

Results Use of this tool identified key preparedness activities in the areas of: scene management, communication, patient transfer optimisation; receiving hospital actions, receiving ED actions, emergency operation centre actions, interfacing with law enforcement and state or federal agencies, patient identification and family reunification, interfacing with the media; incorporation of mental health needs, inter-organisational relationship building; and preparedness investment. Based on peer-assessor and pilot-site feedback, use of this tool was deemed feasible with low burden on sites.

Conclusions The results of these pilots, and the use of this tool following future incidents, can be used to create a de-identified database of best practices for disaster preparation, inform preparedness policy, improve response and guide federal preparedness investments.

Significance Given the current world geopolitical climate effective MCI preparedness is critical. Based on three pilots, critical lessons have been learned that can guide the MCI preparation of hospitals, healthcare systems, and the larger response community.